Provider Demographics
NPI:1225170442
Name:AVALON ANCILLARY SERVICES,L.L.C.
Entity Type:Organization
Organization Name:AVALON ANCILLARY SERVICES,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO BRIGHTON HC SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0157
Mailing Address - Street 1:255 E 400 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2846
Mailing Address - Country:US
Mailing Address - Phone:801-325-0157
Mailing Address - Fax:801-596-9001
Practice Address - Street 1:255 E 400 S
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2846
Practice Address - Country:US
Practice Address - Phone:801-325-0157
Practice Address - Fax:801-596-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========Medicare ID - Type Unspecified